Bone and joint infections by Mucorales, Scedosporium, Fusarium and even rarer fungi.

Mucorales, Scedosporium and Fusarium species are rarely considered as cause for bone and joint infections. However, these moulds are emerging as important fungal pathogens in immunocompromised and immunocompetent patients. Typical pre-disposing host conditions are immunosuppression and diabetes. Most common causative pathogens are Mucorales followed by Scedosporium and Fusarium. Acremonium and Phialemonium species are rare but some case reports exist. MRI is the gold standard imaging technique. Tissue specimens obtained as aspirates, imaging guided biopsy or open surgery need mycological and histopathological work-up for genus and species identification. Multimodal treatment strategies combine surgical debridement, drainage of joints or abscesses, removal of infected prosthetic joints and systemic antifungals. The treatment of mucormycosis is polyene based and may be combined with either posaconazole or - in rare cases - caspofungin. As Scedosporium species are intrinsically resistant to polyenes and azoles show absence of in vitro activity, voriconazole plus synergistic treatment regimens become the therapeutic standard. In fusariosis, fungal susceptibility is virtually impossible to predict, so that combination treatment of voriconazole and lipid-based amphotericin B should be the first-line strategy while susceptibility results are pending. In the absence of randomized controlled trials, infections due to the above moulds should be registered, e.g. in the registries of the European Confederation of Medical Mycology (ECMM).

Pubic symphysitis after transurethral resection of the prostate.

PURPOSE: Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile. MATERIALS AND METHODS: In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4% (n = 4045) were TUR-P, and 84.6% (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297%). RESULTS: Median age was 69.5 years (64-83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10-100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties. CONCLUSION: PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.

Athletic osteitis pubis.

Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity. Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centred directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying efficacies. Future studies of athletic osteitis pubis should attempt to define specific and reliable criteria to make the diagnosis of athletic osteitis pubis, empirically define standards of care and reduce the variability of proposed treatment regimens.

[Osteitis at the service of orthopedics and traumatology at the Hopital Gabriel Toure in Bamako]. / Les osteites dans le Service d'Orthopedie et de Traumatologie de l'Hopital Gabriel Toure de Bamako.

UNLABELLED: The osteitis is a frequent and dangerous affection in Mali. OBJECTIVE: To describe the epidemio-clinical and therapeutic aspects of the osteitis in the service of Orthopedic and Traumatology of Gabriel TOURE hospital of Bamako. MATERIAL AND METHODS: The study was retrospective and carried on 145 osteitis recovered among 130 patients of January 1994 to December 2003. Have been included the patients affected by osteitis and treaties in the service during the period of study. Have not been included those that presented other bony affections. RESULTS: The set counts 80.77% of men, 19.23% of women, sex ratio 4.2, age middle 21 years 2 months with extremes of 2 and 86 years. The most affected age group was 11-20 years with 48.46%. The pupils--students were the more concerned with 30.77%. Normal haemoglobin AA has been found at 80.77% of the patients; on the other hand 19.23% had a hemoglobinopathy. The etiology post-traumatic has been found in 57.70% of the cases. The germ the more frequently recovered was the staphylococcus aureus: 58.63%. The lower member has been reached more frequently: 79.31%. The most often reached bone was the tibia--48.28%. The hold in initial charge was made by the traditional healer at 57.69% of the patients. Have been treated 74.48% of the osteitis surgically. The sequestrectomy with bony curettage was the surgical technique the more used: 60.18%. The antibiotics have been used in the treatment of the osteitis according to the sensitivity of the germs identified. They have been prescribed alone or in association. The result of the treatment of the osteitis was good in 50.34% of the cases, means in 24.14% and bad in 25.52%. CONCLUSION: The osteitis stays an important problem because a very big number of our populations have recourse in case of illness, to the traditional healer, the impostor or the marabou. The antibiotics certainly revolutionized the treatment of the osteitis but their use must be more discriminatory based on a very precise antibiogramm. The surgery keeps a place of choice again in the treatment of the osteitis.